Wednesday, November 3, 2010

Improving State Medicaid Systems

Several states involved in planning for the Replacement of their Medicaid Management Information Systems (R-MMIS) are involved in several tasks. Some states are looking at vendor product demonstrations, requesting information on requirements to appear in future RFPs, and some states have issued the R-MMIS RFP. In developing the R-MMIS, the states are discussing state and system needs in order to prepare an accurate RFP that meets the vision of each individual state involved in R-MMIS.

New Jersey has plans to replace their existing Medicaid Management Information System (MMIS). The State of New Jersey’s Division of Medical Assistance and Health Services (DMAHS) on September 13, 2010 extended an offer to vendors to demonstrate product solutions on October 12-18 before state officials in preparation for the potential release of a future RFP.

The DMAHS held the event to gather product solutions from as many vendors as possible demonstrating a complete MMIS solution or solutions with select capabilities such as Pharmacy Benefit Management, Benefit Plan Management, Third Party Liability, Care Management, or Surveillance and Utilization Review.

The state of Louisiana’s Department of Health and Hospitals on September 22, 2010 issued three Requests for Information (RFI) to help develop requirements for a proposal solicitation to find ways to replace the current MMIS. It is anticipated that in the future there will be one solicitation or RFP issued for an all inclusive Enterprise MMIS. The closing date for the RFIs was October 6, 2010.

The South Carolina Department of Health and Human Services (SCDHHS) issued a notification updating the “Replacement Medicaid Management Information System (MMIS) project. The notification was released to provide preliminary information to vendors but SCDHHS is not seeking proposals at this time.

The state plans to award a single contract to a vendor possibly with subcontractors or partners to replace the current system. Awarding a single contract will shift more work to the vendor and as a result, produce a smaller state team. Also, the state’s goal is to minimize new software development by basing systems on government or commercial off the shelf applications.

The New York Department’s Office of Health Insurance Programs (OHIP) is responsible for administering a wide variety of public health insurance programs including Medicaid and plans to replace their MMIS. An RFP to replace the MMIS was issued in June 2010, and the State received proposals by October 29, 2010. The Department envisions multiple overlapping phases including project planning, implementation, certification, and system and operational enhancements.

According to the Missouri State Medicaid Health Information draft plan released on October 5th, Missouri’s current MMIS system is a legacy mainframe system. Right now, the system is undergoing enhancements and reengineering to improve flexibility, extensibility, and interoperability, as well as support the Missouri Clinical Management Services, Pharmacy (CMSP), and the Prior Authorization System.

CMSP is an extension of the MMIS similar to a data warehouse. It is a web-based HIPAA-compliant data repository supported by tools and applications that enable health care providers to access patient data from MO HealthNet, DSS, DHSS, and DMH. The system enables providers to view a participant’s claim history, prior authorization, some laboratory data, and early and periodic screening, diagnosis, and treatment services.

The Utah Department of Health sent a letter dated September 30, 2010 to the Office of the Legislative Fiscal Analyst in the Capitol referencing the project schedule for their replacement of their Medicaid Management Information System. The individual components going into the MMIS replacement includes a pre-payment editing system, a fraud and abuse detection system, and a point of sale and drug rebate system.